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Application for Employment Miller Transportation, Inc. (“Miller”) is an equal opportunity employer and maintains a

Application for Employment

Miller Transportation, Inc. (“Miller”) is an equal opportunity employer and maintains a policy of nondiscrimination with employees and applicants for employment. It’s policies, procedures, personnel programs are administered to insure that neither employees or applicants are subjected to discrimination on the basis of race, color, religion, sex, age, national origin, pregnancy, physical or mental disability, gender identity, sexual orientation, status as a veteran, status as a smoker, familial status or genetic information (GINA). Persons being considered for employment with Miller will be evaluated based on their experience /academic credentials and ability to meet the essential requirements of the job.

Date

Last name

First name

Middle name

Street Address

City

State

ZIP

Telephone (

)

Social Security #

Cell Phone (

)

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) Yes No

Are you 18 years or older?

Yes No

Have you in the preceding two (2) years in any Pre-Employment drug/alcohol test produced a

positive test result or refused to test?

Yes

No

drug/alcohol test produced a positive test result or refused to test?  Yes  No Updated
drug/alcohol test produced a positive test result or refused to test?  Yes  No Updated

EMPLOYMENT DESIRED Position applied for How did you hear of this opening? Have you ever applied for employment here?

 Yes

Yes

No

If YES, when? Have you ever been employed by this company? Yes If YES, when?

No

Name of last Supervisor? Are you presently employed? Yes

No

Supervisor? Are you presently employed?  Yes  No May we contact your present employer? 

May we contact your present employer? Yes

No

Are you available for full-time work?

Yes

No

Are you available for part-time work? Yes

Do you have a CDL? Yes

Class

No

Endorsement(s)

If YES, state issued, license number, exp. date:

Date you can start

Desired starting salary

Please list applicable skills

$

per

No

EDUCATION

School Name and Location

Did you

Field of

Diploma/

Graduate?

Study

Degree

High School College Post-College Technical School Other Training Are there are other skills, qualifications, or experience that we should consider?

Other Training Are there are other skills, qualifications, or experience that we should consider? Updated 3/2014
Other Training Are there are other skills, qualifications, or experience that we should consider? Updated 3/2014

EMPLOYMENT HISTORY

(List last 3 employers starting with most recent)

Company Name Address Date Started

Reason for leaving

Starting Wage

Telephone Starting Position

Date Ended

Ending Wage

Ending Position

Name of Supervisor

May we contact? Yes

No

Responsibilities

Company Name Address Date Started

Reason for leaving

Starting Wage

Telephone Starting Position

Date Ended

Ending Wage

Ending Position

Name of Supervisor

May we contact? Yes

No

Responsibilities

Company Name Address Date Started

Starting Wage

Telephone Starting Position

Date Ended

Ending Wage

Ending Position

Name of Supervisor Responsibilities

May we contact? Yes

No

Reason for leaving

Name of Supervisor Responsibilities May we contact?  Yes  No Reason for leaving Updated 3/2014
Name of Supervisor Responsibilities May we contact?  Yes  No Reason for leaving Updated 3/2014

MILITARY SERVICE RECORD

Branch of Service

Discharge Date

Discharge Rank

Special

Training

REFERENCES

List three personal references, not related to you, who have known you for more than 1year.

Name

Phone

Years

Known

Address

Name

Phone

Years

Known

Address

Name

Phone

Years

Known

Address

PLEASE READ BEFORE SIGNING:

I certify that all information provided by me on this application is true and complete to the best

of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of

this application.

I authorize my previous employers, schools, or persons listed as references to give any

information regarding employment or educational record. I agree that Miller and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or

employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with Miller, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to Miller that verifies my right to work in the United States on the first day of employment (form I-9). I have or will receive from Miller a list of the approved documents that are required.

I understand that employment at Miller is AT WILL,” which means that either I or Miller can

terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby

acknowledge that I have read and understand the above statements.

Signature

Date

basis. I hereby acknowledge that I have read and understand the above statements. Signature Date Updated
basis. I hereby acknowledge that I have read and understand the above statements. Signature Date Updated